State-of-the-Art CT Imaging of the Left Atrium

Karády, Júlia; Whitaker, John; Rajani, Ronak; Maurovich-Horvat, Pál

doi:10.1007/s40134-016-0171-y

Cited by 3 publications

(3 citation statements)

References 101 publications

(108 reference statements)

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“…ICE is an invasive and expensive procedure, most commonly used to assist in performing a transseptal puncture for left atrial RFCA (28, 29). The ability of contrast-enhanced CT to detect LAA thrombus has been confirmed by several studies and metaanalyses (26,27,30). On the other hand, it is associated with radiation exposure, contrast allergy, and the worsening of chronic kidney disease that is often associated with atrial fibrillation (31).…”

Section: Laa Thrombus Assessmentmentioning

confidence: 94%

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Use of a new non-contrast-enhanced BOOST cardiac MR sequence before electrical cardioversion or ablation of atrial fibrillation—a pilot study

Orbán

Dohy

Suhai

et al. 2023

Front. Cardiovasc. Med.

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IntroductionLeft atrial appendage (LAA) thrombus is the most common source of embolization in atrial fibrillation (AF). Transesophageal echocardiography (TEE) is the gold standard method for LAA thrombus exclusion. Our pilot study aimed to compare the efficacy of a new non-contrast-enhanced cardiac magnetic resonance (CMR) sequence (BOOST) with TEE for the detection of LAA thrombus and to evaluate the usefulness of BOOST images for planning radiofrequency catheter ablation (RFCA) compared with left atrial (LA) contrast-enhanced computed tomography (CT). We also attempted to assess the patients' subjective experiences with TEE and CMR.MethodsPatients with AF undergoing either electrical cardioversion or RFCA were enrolled. Participants underwent pre-procedural TEE and CMR scans to evaluate LAA thrombus status and pulmonary vein anatomy. Patient experiences with TEE and CMR were assessed using a questionnaire developed by our team. Some patients scheduled for RFCA also had pre-procedural LA contrast-enhanced CT. In such cases, the operating physician was asked to subjectively define the quality of the CT and CMR scan on a scale of 1–10 (1 = worst, 10 = best) and comment on CMR's usefulness in RFCA planning.ResultsSeventy-one patients were enrolled. In 94.4%, both TEE and CMR excluded, and in 1 patient, both modalities reported the presence of LAA thrombus. In 1 patient, TEE was inconclusive, but CMR excluded LAA thrombus. In 2 patients, CMR could not exclude the presence of thrombus, but in 1 of those cases, TEE was also indecisive. During TEE, 67%, during CMR, only 1.9% of patients reported pain (p < 0.0001), and 89% would prefer CMR in case of a repeat examination. The quality of the left atrial contrast-enhanced CT scans was better compared with the image quality of the CMR BOOST sequence [8 (7–9) vs. 6 (5–7), p < 0.0001]. Still, the CMR images were useful for procedural planning in 91% of cases.ConclusionThe new CMR BOOST sequence provides appropriate image quality for ablation planning. The sequence might be useful for excluding larger LAA thrombi; however, its accuracy in detecting smaller thrombi is limited. Most patients preferred CMR over TEE in this indication.

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Section: Laa Thrombus Assessmentmentioning

confidence: 94%

“…Data from the 71 enrolled patients [age 65 (57-72) years, 38% female] were collected and analyzed. Fifty-two percent of patients had paroxysmal AF, the BMI was 28 (26)(27)(28)(29)(30)(31)(32) kg/m 2 , and 77% had hypertension. Two point eight percent of them had a prior stroke or TIA.…”

Section: Characteristics Of the Study Populationmentioning

confidence: 99%

Use of a new non-contrast-enhanced BOOST cardiac MR sequence before electrical cardioversion or ablation of atrial fibrillation—a pilot study

Orbán

Dohy

Suhai

et al. 2023

Front. Cardiovasc. Med.

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“…RGCT can be indicated for pre-procedural planning in cardiac resynchronisation therapy (CRT) and is clinically indicated in patients undergoing transcatheter aortic valve replacement (TAVR) for valvular sizing ( 13 ). The high CT spatial resolution enables RGCT to produce high-fidelity 4D (3D + time) images of the complex LA anatomy ( 14 ). Therefore, in this study, we hypothesise that RGCT with FT can be used to provide a detailed regional estimation of 3D LA mechanics.…”

Section: Introductionmentioning

confidence: 99%

A three-dimensional left atrial motion estimation from retrospective gated computed tomography: application in heart failure patients with atrial fibrillation

Sillett,

Razeghi,

Lee

et al. 2024

Front. Cardiovasc. Med.

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BackgroundA reduced left atrial (LA) strain correlates with the presence of atrial fibrillation (AF). Conventional atrial strain analysis uses two-dimensional (2D) imaging, which is, however, limited by atrial foreshortening and an underestimation of through-plane motion. Retrospective gated computed tomography (RGCT) produces high-fidelity three-dimensional (3D) images of the cardiac anatomy throughout the cardiac cycle that can be used for estimating 3D mechanics. Its feasibility for LA strain measurement, however, is understudied.AimThe aim of this study is to develop and apply a novel workflow to estimate 3D LA motion and calculate the strain from RGCT imaging. The utility of global and regional strains to separate heart failure in patients with reduced ejection fraction (HFrEF) with and without AF is investigated.MethodsA cohort of 30 HFrEF patients with (n = 9) and without (n = 21) AF underwent RGCT prior to cardiac resynchronisation therapy. The temporal sparse free form deformation image registration method was optimised for LA feature tracking in RGCT images and used to estimate 3D LA endocardial motion. The area and fibre reservoir strains were calculated over the LA body. Universal atrial coordinates and a human atrial fibre atlas enabled the regional strain calculation and the fibre strain calculation along the local myofibre orientation, respectively.ResultsIt was found that global reservoir strains were significantly reduced in the HFrEF + AF group patients compared with the HFrEF-only group patients (area strain: 11.2 ± 4.8% vs. 25.3 ± 12.6%, P = 0.001; fibre strain: 4.5 ± 2.0% vs. 15.2 ± 8.8%, P = 0.001), with HFrEF + AF patients having a greater regional reservoir strain dyssynchrony. All regional reservoir strains were reduced in the HFrEF + AF patient group, in whom the inferior wall strains exhibited the most significant differences. The global reservoir fibre strain and LA volume + posterior wall reservoir fibre strain exceeded LA volume alone and 2D global longitudinal strain (GLS) for AF classification (area-under-the-curve: global reservoir fibre strain: 0.94 ± 0.02, LA volume + posterior wall reservoir fibre strain: 0.95 ± 0.02, LA volume: 0.89 ± 0.03, 2D GLS: 0.90 ± 0.03).ConclusionRGCT enables 3D LA motion estimation and strain calculation that outperforms 2D strain metrics and LA enlargement for AF classification. Differences in regional LA strain could reflect regional myocardial properties such as atrial fibrosis burden.

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Imaging for electrophysiological procedures

O’Neill¹,

Sim²,

Whitaker³

et al. 2021

The ESC Textbook of Cardiovascular Imaging

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Electrophysiology is one of the most rapidly growing area of cardiology. Currently >50,000 catheter ablations are performed in Europe every year and >200,000 patients receive a device for arrhythmia treatment, sudden death prevention, or cardiac resynchronization. The advantages and limitations of fluoroscopy are well known. The rapid development of implantable cardiac devices therapies and ablation procedures all depend on accurate and reliable imaging modalities for preprocedural assessments, intraprocedural guidance, detection of complications, and post-procedural assessment for the longitudinal follow-up of patients. Therefore, over the last decades, imaging become an integral part of electrophysiological procedures.

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State-of-the-Art CT Imaging of the Left Atrium

Cited by 3 publications

References 101 publications

Use of a new non-contrast-enhanced BOOST cardiac MR sequence before electrical cardioversion or ablation of atrial fibrillation—a pilot study

Use of a new non-contrast-enhanced BOOST cardiac MR sequence before electrical cardioversion or ablation of atrial fibrillation—a pilot study

A three-dimensional left atrial motion estimation from retrospective gated computed tomography: application in heart failure patients with atrial fibrillation

Imaging for electrophysiological procedures

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